Nd:YAG laser pleurodesis through thoracoscopy: new curative therapy in spontaneous pneumothorax

From January 1986 to May 1987, 14 patients with spontaneous pneumothorax were treated in our department with a new endoscopic method using neodymium:yttrium-aluminum-garnet laser photocoagulation through thoracoscopy. The 10 male and 4 female patients ranged in age from 14 to 59 years (mean age, 29 years). In all patients, the procedure was performed under general anesthesia. The thoracoscope was introduced through a 1- to 1.5-cm incision in the anterior axillary line of the fourth intercostal space. The fiber of the laser was advanced through the operative channel of the thoracoscope. In all patients, the bleb (or blebs) detected in the apex of the upper lobe was successfully coagulated with low-power laser pulses. Then the parietal pleura of the first five ribs was partially scarified to achieve pleurodesis. There were no side effects. Thirteen patients were successfully treated without recurrence (maximum follow-up, 29 months). We conclude that this new therapy can play an important role in select patients with spontaneous pneumothorax.